The more doctors that treat a patient is not necessarily better. It’s time to change the carrot:
Despite seeing many doctors, few patients get the treatments that are recommended for them, and few have their chronic diseases well-managed. For example, fewer than 30% of people with high blood pressure have it adequately controlled, according to the agency’s most recent analysis of health-care quality. No surprise, really. Fee for service incentives are linked to the number of services doctors provide, not the quality of those services.
Related posts:
- Flawed Medicare pay formula
- America’s failed attempt at a single-payer system, the Indian Health Service
- Medicare: No incentives to control costs
- Health care costs 101
- Fee-for-service: A barrier to health reform
- US physicians kick butt on hypertension control
- Medicare: The big asterisk
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So what’s the solution? Capitation? Adjusted capitation based on chronic conditions/other criteria?
Solution is a flat salary.
Only that will stop the ridiculous upsurge in unnecessary procedures, particuarly by the specialists.
There’s a reason where every single person who sees a GI doc gets an EGD or colonoscopy, and its not becasue of defensive medicine. Its because of $$$$$
Ah yes. What would a day be like without the requisite class envy rant about “proceduralists” by one of Kevin’s fans.?
Guess what? We divide the capitated pie in our group based on production. That is the American way. Capitation attempts to shift insurance risk to physicians and we don’t play that game. If a contract is not profitable, we drop it. Capitated patient populations must be managed of course to be profitable. This occurs by limiting the number of nonemergency appointment slots and limiting the number of elective surgeries performed per week. This may mean that you must wait for your nonemergency appointment or surgery, just like in Canada or England. You get what you pay for.
And a flat salary will allow less to have access to care. If I’m paid on salary I will stroll in 15 minutes late, see a patient take a coffee break, see another, take a 2 hour lunch, see another couple and go home. Instead of seeing 40 a day I think 4 is about right. Healthcare costs will drop through the floor, but people won’t like waits that put the NHS to shame. Don’t expect me to take call either.
The solution is to for Medicare to pay what it can and to balance bill for the rest. This is the American way. Doctors should set their own rates, and better doctors should command higher fees. Patients can decide who they want to see and what they can afford. I’m tired of being reimbursed the same pittance as my less skilled counterparts and I would like to be able to afford a caring, skilled, and compassionate staff. I would also like to have an office furnished better than the county jail. It takes money and Medicare/insurance reimbursements are not sufficient.
The solution is for physicians to stop signing the contracts that pay them this way. Contracts that guarantee them a pretty good standard of living.
So how many are willing to do it?
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